J Korean Neurosurg Soc.  2012 May;51(5):253-261. 10.3340/jkns.2012.51.5.253.

Morphometric Study of Hypoglossal Nerve and Facial Nerve on the Submandibular Region in Korean

• Shin DS
• Bae HG
• Shim JJ
• Yoon SM
• Kim RS
• Chang JC

• KMID: 2066922
• DOI: http://doi.org/10.3340/jkns.2012.51.5.253

Abstract

OBJECTIVE
This study was performed to determine the anatomical landmarks and optimal dissection points of the facial nerve (FN) and the hypoglossal nerve (HGN) in the submandibular region to provide guidance for hypoglossal-facial nerve anastomosis (HFNA).
METHODS
Twenty-nine specimens were obtained from 15 formalin-fixed adult cadavers. Distances were measured based on the mastoid process tip (MPT), common carotid artery bifurcation (CCAB), and the digastric muscle posterior belly (DMPB).
RESULTS
The shortest distance from the MPT to the stylomastoid foramen was 14.1+/-2.9 mm. The distance from the MPT to the FN origin was 8.6+/-2.8 mm anteriorly and 5.9+/-2.8 mm superiorly. The distance from the CCAB to the crossing point of the HGN and the internal carotid artery was 18.5+/-6.7 mm, and that to the crossing point of the HGN and the external carotid artery was 15.1+/-5.7 mm. The distance from the CCAB to the HGN bifurcation was 26.6+/-7.5 mm. The distance from the digastric groove to the HGN, which was found under the DMPB, was about 35.8+/-5.7 mm. The distance from the digastric groove to the HGN, which was found under the DMPB, corresponded to about 65.5% of the whole length of the DMPB.
CONCLUSION
This study provides useful information regarding the morphometric anatomy of the submandibular region, and the presented morphological data on the nerves and surrounding structures will aid in understanding the anatomical structures more accurately to prevent complications of HFNA.

Keyword

Facial nerve; Hypoglossal nerve; Morphometric anatomy

MeSH Terms

Adult
Cadaver
Carotid Artery, Common
Carotid Artery, External
Carotid Artery, Internal
Facial Nerve
Humans
Hypoglossal Nerve
Mastoid
Muscles

Figure

• 

  Fig. 1 Neurovascular structures of the submandibular area. A : Photograph showing cadaveric dissection of the submandibular region. Most of the facial nerve (FN) trunk are found in the ventral portion of the mastoid process tip (MPT). Dissection of the FN proximally in the posterior parotid gland (PG) exposed the distal FN trunk and pes anserinus, which is the ramification point of the FN trunk in the PG. B : Schematic representation. Anatomical landmarks are MPT, DMPB, and common carotid artery bifurcation. DMPB : digastric muscle posterior belly.

• 

  Fig. 2 Measurements of the distance from the mastoid process tip (MPT) to the stylomastoid foramen (SMF). A : Photograph showing cadaveric dissection of the submandibular region. B : Schematic representation. (A) The shortest distance between the two points. (B) Horizontal distance between the MPT and the SMF. (C) Vertical distance between the SMF and the MPT.

• 

  Fig. 3 The digastric muscle posterior belly (DMPB) and hypoglossal nerve (HGN). A : Photograph showing cadaveric dissection of the submandibular region. B : Schematic representation. (A) Whole length of the DMPB. (B) Distance from the DMPB origin to the crossover point of the DMPB inferior border and HGN.

• 

  Fig. 4 Relationship between the hypoglossal nerve (HGN) and the carotid artery. A : Photograph showing cadaveric dissection of the submandibular region. B : Schematic representation. (A) Distance from the common carotid artery bifurcation (CCAB) to the crossover point between the external carotid artery and the HGN. (B) Distance from the CCAB to the crossover point between the internal carotid artery and the HGN. (C) Distance from the CCAB to the HGN bifurcation.

• 

  Fig. 5 Photographs showing the relationships among the DMPB, HGN, carotid vessels, and IJV. A : The HGN, neck vessels, and DMPB. B : Magnified view. The white arrow indicates the HGNB. The HGN is located between the ICA and the IJV. It runs parallel to the ICA, gives rise to (white arrow) branches with the ansa cervicalis and crosses the ICA. Separate branches of HGN were found between the DMPB and the CCAB. CCAB : common carotid artery bifurcation, ICA : internal carotid artery, ECA : external carotid artery, DMPB : digastric muscle posterior belly, HGN : hypoglossal nerve, HGNB : hypoglossal nerve bifurcation, AC : ansa cervicalis, IJV : internal jugular vein.

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